Provider Demographics
NPI:1013116367
Name:SMITH, VANESA P (SLP)
Entity Type:Individual
Prefix:
First Name:VANESA
Middle Name:P
Last Name:SMITH
Suffix:
Gender:F
Credentials:SLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12420 SOMBRA GRANDE DR
Mailing Address - Street 2:
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79938-4485
Mailing Address - Country:US
Mailing Address - Phone:915-274-7521
Mailing Address - Fax:
Practice Address - Street 1:1477 LOMALAND DR STE E7
Practice Address - Street 2:
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79935-4704
Practice Address - Country:US
Practice Address - Phone:915-599-6690
Practice Address - Fax:915-592-7168
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2009-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102738235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX182595201Medicaid